子宫内膜厚度和胚胎移植位置与临床妊娠率的相关性

目的 探讨体外受精-胚胎移植(IVF-ET)过程中胚胎移植的位置和子宫内膜厚度与临床妊娠率的相关性.方法 回顾分析266例患者接受276个周期IVF-ET治疗的资料,根据子宫内膜厚度将患者分为A组(7～8.9 mm)和B组(9～16 mm);根据移植管距宫底的距离分为C组(5～10 mm)和D组(10～20 mm),分别比较A组与B组、C组与D组的临床妊娠率.结果 B组的临床妊娠率(50.00%)高于A组(23.33%),差异有统计学意义(P<0.05);C组临床妊娠率(45.86%)与D组(48.74%)间差异无统计学意义(P＞0.05).结论 IVF-ET过程中,超声导向能准确地显示子宫内膜厚度及胚胎放置在宫腔内的位置;子宫内膜厚度9～16 mm、移植胚胎距宫底5～20 mm有利于胚胎着床.     

新鲜周期体外受精-胚胎移植位置对妊娠结局的影响

目的:研究新鲜周期体外受精-胚胎移植(IVF-ET)助孕患者胚胎移植于宫腔不同位置对临床妊娠结局的影响。方法:分析郑州大学第二附属医院生殖医学中心新鲜周期移植胚胎助孕308周期,胚胎移植后腹部超声下气液滴强回声与宫底间距离并分为4组,A组:0~1.0 cm共86周期,B组:1.1~1.5cm共67周期,C组:1.6~2.0 cm共81周期,D组:>2.0 cm共74周期,分析比较各组间妊娠结局有无差异。结果:胚胎移植后气液滴距宫底距离4组间胚胎临床妊娠率、异位妊娠率,流产率等均无统计学差异(P>0.05),其中D组胚胎种植率较其他组高,但结果仍无统计学差异(P>0.05)。结论:新鲜周期IVFET胚胎移植位置对妊娠结局无影响。     

经阴道超声在输卵管间质部妊娠中的应用

目的:分析经阴道超声在输卵管间质部妊娠中的应用效果。方法:回顾分析我院2017年2月至2019年4月期间收治的输卵管间质部妊娠患者62例,各患者均接受经阴道二维超声和三维超声检查,并将检查结果与手术病理检查或妊娠结局进行比较分析,以明确经阴道超声检查输卵管间质部妊娠的效果。结果:62例患者接受二维、三维阴道超声检查后,孕囊与宫腔相通率为12.90%(8/62),孕囊附近肌层包绕厚度为(2.12±0.85)mm,RI为(0.45±0.10),EDV为(0.27±0.08)m/s,PSV为(0.46±0.17)m/s。比较确诊率,阴道三维超声检查确诊率93.55%高于阴道二维超声检查率66.13%,数据差异有统计学意义(P<0.05)。结论:临床诊断输卵管间质部妊娠时,采用经阴道三维超声方式,此方式可提供更多妊娠囊、宫腔形态的声学信息,诊断准确性更高。     

胚胎移植管的选择对体外助孕技术成功率的影响

目的研究胚胎移植管(ET管)对接受体外助孕技术患者成功率的影响.方法将381例接受体外助孕技术的患者随机分为两组采用不同的ET管行胚胎移植,观察ET管放置的难易度、是否应用辅助器械协助及ET管是否沾血等.结果 381例不孕症患者,经新鲜胚胎移植432个周期,其年龄、移植胚胎数及胚胎评分无明显差异(P＞0.05);其中220个周期采用1307100型ET管移植,获得临床妊娠85例,妊娠率为38.64%.212个周期采用普通ET管移植,获得临床妊娠59例,妊娠率为27.83%.可见1307100型ET管沾血程度及借助辅助器械移植较普通ET管机率少,差异显著(P＜0.001).结论选择ET导管对体外助孕技术周期成功有影响,应用1307100型ET管较普通型ET管操作简单、损伤少、成功率高,值得推广.     

冻融卵裂期胚胎当日解冻与提前解冻移植对临床妊娠结局的影响

目的探讨解冻移植周期中卵裂期胚胎当天解冻移植和提前解冻过夜培养后移植对临床妊娠结局的影响。方法回顾性分析2017年1-4月在该院生殖中心接受冻融卵裂期胚胎移植治疗的277例患者,即277个冻融卵裂期胚胎移植周期。根据解冻后胚胎培养时间分为当日解冻组(A组162个周期)和提前解冻组(B组115个周期);根据患者的年龄,A组B组分别分成3组,即A1、B1:年龄30岁,A2、B2:年龄30～35岁和A3、B3:年龄≥35岁,比较各组间的移植结局。结果 A组与B组临床妊娠率分别为38.27%、43.48%,着床率分别为24.68%、26.98%,差异无统计学意义(P0.05)。A3、B3分别与A1、B1,A2、B2相比,其临床妊娠率和着床率均明显降低,差异有统计学意义(P0.05)。结论冻融卵裂期胚胎提前解冻培养后再进行移植并不能改善妊娠结局,但随着女性年龄的增高,临床妊娠率和着床率均会随之下降。     

经阴道二维联合三维超声对剖宫产后子宫瘢痕妊娠的诊断价值

目的研究经阴道二维联合三维超声对剖宫产术后子宫瘢痕妊娠(CSP)的诊断价值。方法选取手术治疗的CSP患者60例,术前进行超声检查时随机分为二维组、二维及三维组,观察瘢痕妊娠的二维声像图表现、血流供应特点及三维成像特征,并与术后结果相对照,比较两组间的诊断准确率。结果经手术病理证实,经阴道二维组30例患者Ⅰ型9例,Ⅱ型10例,Ⅲ型4例,诊断符合率为76.67%。经阴道二维及三维组30例患者Ⅰ型9例,Ⅱ型14例,Ⅲ型5例,诊断符合率为93.33%,两组诊断符合率差异具有统计学意义(P0.05)。结论三维超声能更直观、立体的显示妊娠囊的位置、形态,经阴道二维联合三维超声能显著提高CSP的诊断准确率,为临床早诊断早治疗提供切实有效的诊断方法。     

三维超声容积成像在胎盘形态异常产前诊断中的价值

目的 探讨三维超声在胎盘形态异常产前诊断中的临床价值.方法 二维超声怀疑胎盘形态异常孕妇44例,对其胎盘及相关部位进行三维超声容积成像,诊断胎盘形态异常的类型,评价胎盘血管生成及其对子宫-胎盘-胎儿血流交换的影响.结果 44例二维超声怀疑胎盘形态异常孕妇中,三维超声诊断8例正常,36例胎盘形态异常;异常胎盘中副胎盘13例,二叶胎盘6例,球状胎盘1例,球拍状胎盘3例,宫腔粘连带胎盘附着其两侧8例及不全纵隔子宫纵隔两侧胎盘附着5例.三维容积成像与二维超声在诊断各类胎盘形态异常中的价值差异具有统计学意义.结论 多种三维超声成像新技术的结合使用,立体显示胎盘形态显示出脐带进出胎盘的位置及胎盘内血管树的立体构型,更准确的判断胎盘的功能.     

经阴道三维超声成像在宫腔粘连中的诊断价值

目的 探讨经阴道三维超声成像在宫腔粘连中的诊断价值.方法 回顾性分析85例疑为宫腔粘连患者的临床资料,以宫腔镜检查和病理检查为标准,比较经阴道二维超声和三维超声成像对宫腔粘连的检出率,分析患者声像图资料与宫腔粘连程度的关系.结果 二维超声对宫腔粘连患者的诊断准确率和阳性预测值分别为77.50%和78.08%;三维超声对宫腔粘连患者的诊断准确率和阳性预测值分别为94.11%和94.87%,二者比较差异有显著统计学意义（P〈0.05）.三维彩超对中、重度宫腔粘连的检出率为100%.结论 经阴道三维超声成像能简便、有效、无创地诊断宫腔粘连,具有较好的临床应用价值     

经阴道三维超声联合断层超声显像技术在早期异位妊娠诊断中的应用

目的探讨经阴道三维超声联合断层超声显像技术(TUI)在早期异位妊娠诊断中的应用价值。方法对停经4~6周临床疑似异位妊娠的120例患者行经阴道二维及三维超声联合TUI技术检查,做出超声分型诊断;与手术病理及临床随访结果对照,对经阴道二维及三维超声联合TUI技术诊断早期异位妊娠患者的超声声像图特征及漏误诊病例图像特征进行总结分析。结果 120例患者手术病理及临床随访结果证实异位妊娠102例,宫内妊娠18例。与手术病理诊断结果及临床随诊结果对照显示:(1)输卵管妊娠92例,经阴道二维超声正确诊断80例(86.9%,80/92),漏诊8例,误诊4例;经阴道三维超声联合TUI成像正确诊断84例(91.3%,84/92),漏诊8例,无误诊病例。超声声像图示附件区类妊娠囊回声包块,呈"Donut"征或边界不清的不规则包块,多数包块边界和内部结构清晰或较清晰,包块与输卵管位置关系清晰或较清晰。超声诊断未破裂型输卵管妊娠36例,流产型43例,破裂型5例。(2)子宫角妊娠10例,经阴道二维超声正确诊断6例(60.0%,6/10),误诊4例;经阴道三维超声联合TUI成像正确诊断9例(90.0%,9/10),误诊1例。超声声像图示妊娠囊位于一侧子宫角处向外突出,经阴道二维超声显示10例中6例妊娠囊与子宫内膜不相连,4例妊娠囊周边蜕膜包绕显示不清,4例见间质线征;经阴道三维超声联合TUI成像,通过多平面断层图像,尤其冠状面清晰显示9例妊娠囊与子宫内膜不相连,妊娠囊周边蜕膜包绕不完整,6例见间质线征。(3)102例早期异位妊娠因包块小、超声显示不清,经阴道二维及三维超声联合TUI成像均漏诊输卵管妊娠8例;因宫腔内出现"假妊娠囊"结构、妊娠囊偏向一侧与宫内妊娠难以分辨等原因,经阴道二维超声误诊输卵管妊娠4例及子宫角妊娠4例,经阴道三维超声联合TUI成像后清晰显示异位妊娠包块及妊娠囊位置而明确诊断7例,仅误诊1例子宫角妊娠。结论经阴道三维超声联合TUI成像能提供更详尽的早期异位妊娠超声声像图诊断信息,减少早期异位妊娠漏误诊,经阴道三维超声联合TUI成像对早期异位妊娠超声诊断有较好的临床应用价值。     

小鼠超排卵胚胎的着床与白血病抑制因子表达水平的关系

目的：观察受体鼠妊娠和胚胎着床情况,并检测胚胎移植时小鼠子宫内膜中白血病抑制因子（Lif）表达水平,探讨超排卵对小鼠胚胎着床潜能的影响。方法：建立超排周期胚胎和自然周期胚胎移植小鼠模型,比较妊娠率、胚胎着床率的差异及其与Lif蛋白的表达水平之间的关系。结果：超排卵周期受体组的妊娠率（20.00%）和胚胎着床率（8.33%）显著低于自然周期组的妊娠率（55.00%）和胚胎着床率（35.00%）（P〈0.05）。自然周期胚胎和超排周期胚胎受体组内膜中Lif蛋白的表达水平相似（P〉0.05）,妊娠受体组Lif蛋白的表达水平显著高于未孕受体组（P〈0.05）,但单胎妊娠和多胎妊娠受体组内膜中Lif蛋白的表达水平相似（P〉0.05）。结论：超排卵可能降低胚胎的着床潜能,Lif蛋白的表达水平与胚胎着床有关,但与着床胚胎的数目无比例关系。     

Advantages of 3‐Dimensional Sonography in Embryo Transfer

Objective. The purpose of this study was to investigate the advantages of 3‐dimensional (3D) sonography in embryo transfer. Methods. With the use of 2‐dimensional (2D) and 3D sonography to measure the transfer distance from the fundus (TDF), 319 patients were allocated into 4 groups according to the disparity between 2D and 3D images: group 1 showed disparity of less than 3 mm; group 2 showed disparity of 3 to 5 mm; group 3 showed disparity of 6 to 9 mm; and group 4 showed disparity of 10 mm or greater. The general characteristics and pregnancy outcomes were compared among the 4 groups. Results. For 140 patients, the TDF measured by 2D sonography was different from that measured by 3D sonography, with a positive to negative range of 3 to 13 mm. Compared with the first 3 groups, the clinical pregnancy and implantation rates were lowest in group 4 (7.7% versus 34.1%, 38.1%, and 40%; 3.6% versus 18.2%, 21.2%, and 22.2%; P < .05). Conclusions. Compared with 2D sonography, uterine cavity and catheter placement may be better achieved with 3D sonography, which would improve the embryo transfer technique.     

Three-dimensional ultrasound in embryo transfer.

OBJECTIVE: To examine the feasibility of using three-dimensional (3D) ultrasound (US) guidance in routine embryo transfer (ET) procedures. METHODS: Seventy-five ETs were performed using a 3D US scanner to locate the catheter tip in the uterine cavity. RESULTS AND CONCLUSION: Three-dimensional ultrasound could show the exact position of the tip of the catheter in the uterine cavity quickly enough in most cases. It should be used in ET for seeking an optimal transfer area in the uterine cavity to assist in achieving high success rates and less complications.     

经阴道超声检测激素替代周期子宫内膜血流参数对胚胎移植妊娠结局的评估价值

目的:探讨经阴道超声检测激素替代周期胚胎移植中内膜转化日子宫内膜厚度、子宫内膜血流等参数对妊娠结局的评估价值。方法:选择100例于激素替代周期行冻融胚胎移植的不孕症患者,根据妊娠结果分为妊娠组(n=60)与未妊娠组(n=40)。比较两组子宫内膜转化日的子宫内膜厚度、内膜血流搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、收缩期峰值流速与舒张末期流速比值(systolic-diastolic ratio,S/D)等参数。结果:两组内膜转化日的雌二醇(estradiol,E2)、黄体生成素(luteinizing hormone,LH)、卵泡刺激素(follicle stimulation hormone,FSH)水平,优质胚胎数及子宫内膜厚度差异均无统计学意义。与未妊娠组比较,妊娠组内膜PI、RI、S/D等血流动力学参数明显降低(P<0.05)。转化日子宫内膜厚度<8 mm者妊娠率低于子宫内膜厚度≥8 mm者(P<0.05)。妊娠组转化日内膜S/D>3者的比例低于非妊娠组(P<0.05)。结论:经阴道超声检测子宫内膜血流参数,有助于预测激素替代周期胚胎移植的妊娠结局。     

子宫肌壁间妊娠超声诊断分析

目的总结子宫肌壁间妊娠超声图像特征及鉴别诊断要点。方法对2008年1月至2013年12月南方医科大学附属深圳市妇幼保健院收治的4例子宫肌壁间妊娠患者临床、超声分型表现及手术病理检查、临床诊治结果进行总结分析。结果 4例患者中1例早期超声诊断正确,3例超声误诊,手术及病理检查证实为子宫肌壁间妊娠后重新对超声图像予以分型。4例子宫肌壁间妊娠患者超声分型表现及临床诊治结果：（1）妊娠囊型2例,1例入院前超声显示子宫底后壁肌层内妊娠囊回声,与子宫腔不相通,与子宫内膜不相连接,妊娠囊四周肌层包绕,周边肌层内血管扩张、血流丰富,超声诊断为子宫底后壁肌壁间妊娠,经甲氨蝶呤保守治疗成功。另一例术前超声显示左侧子宫腔内妊娠囊回声,胚胎存活,误诊为子宫左侧宫内妊娠,清宫手术失败后再次超声检查显示子宫下段左侧后壁肌层内妊娠囊,胚胎存活,妊娠囊内缘与子宫内膜不相连接,四周肌层包绕;剖腹探查术后病理诊断为子宫下段左侧后壁肌壁间妊娠。（2）包块型1例,入院前超声显示子宫右侧宫角处混合回声包块,包块内缘紧贴子宫内膜,周边可见菲薄肌层包绕,包块内部及周边肌层血管扩张、血流丰富,超声误诊为子宫右侧宫角妊娠,宫腔镜及腹腔镜手术后病理诊断为子宫右侧宫角前壁肌壁间妊娠。（3）破裂型1例,入院前超声显示子宫后方偏右侧混合回声包块,包块紧贴子宫右后壁,与子宫肌层关系密切,盆腔内透声差的无回声区,超声误诊为右侧输卵管异位妊娠破裂,腹腔镜手术后病理诊断为子宫右侧后壁肌壁间妊娠。3例患者明确诊断后均经临床治愈。结论子宫肌壁间妊娠罕见,超声显示妊娠囊（或包块）位于子宫肌层内,与子宫腔不相通,与子宫内膜不相连接,四周由子宫肌层包绕,肌层内血管扩张、血流丰富者可提示为子宫肌?     

阴道超声联合超声造影对早孕期瘢痕妊娠的诊断价值

目的 探究阴道超声联合超声造影测定子宫瘢痕厚度对瘢痕妊娠的诊断价值。方法 选取我院2019年12月～2021年12月收治的92例疑似瘢痕妊娠患者为研究对象,采用阴道超声与超声造影对患者进行孕早期子宫瘢痕厚度测定,比较两种检查方式相关图像表现结果与病理检查结果,采用ROC曲线判断其厚度对瘢痕妊娠的诊断效能。结果 阴道超声测量结果为7.03±0.17 mm,超声造影结果为7.25±0.14 mm,病理检查结果为7.42±0.15 mm,超声造影检查的厚度高于经阴道超声（P<0.05）,两种方式检查结果均低于病理检查结果（P<0.05）。对两种检查方式的图像进行比较,阴道超声检查诊断为92例患者均无法排除瘢痕妊娠,其中83例患者明确观察到妊娠物着床于瘢痕处,确诊为瘢痕妊娠,另9例患者无法确定其着床位置,无法排除瘢痕妊娠。进行超声造影后发现,有86例患者诊断为瘢痕妊娠,其中孕囊型57例,包块型29例,6例组织物植入肌层。病理检查结果显示,瘢痕妊娠88例,非瘢痕处峡部妊娠2例,妊娠着床位置过低2例。经阴道超声诊断准确度为92.39%,敏感度为94.31%,特异性为50.00%,超声造...     

Subendometrial-myometrial contractility in conception and non-conception embryo transfer cycles.

This study describes the characteristics of subendometrial-myometrial contractions seen on transvaginal sonography on the day of embryo transfer in assisted conception cycles and their significance for pregnancy outcome.A total of 112 cycles were studied where three embryos with minimal or no fragmentation were transferred. Transvaginal sonography was performed just prior to embryo transfer. A sagittal view of the uterine cavity was obtained and the ultrasound probe was held steady for 2 min. The video recorded image was analyzed at normal, three and five times normal speed. The frequency (contractions/min), direction (fundally or cervically directed) and length (entire cavity or localized) of contractions were noted. Conception and non-conception cycles were compared by determining the standard error of difference between means and proportions and the confidence intervals.The mean frequencies of contractions in the conception and non-conception cycles were 2.09 (SD = 0.8) and 1.92 (SD = 0.85), respectively. A total of 57.6% of cycles in the conception group and 46% in the non-conception group had contractions directed towards the cervix. There was no statistically significant difference between the two groups in any of the parameters studied. However, when frozen embryo replacement cycles (n = 40) were studied separately, the incidences of fundally directed contractions were 28.6% and 66.7% in conception and non-conception cycles, respectively. This was statistically significant. Comparison of cycles resulting in miscarriage with those leading to pregnancies beyond 16 weeks revealed no statistical difference in the characteristics of the contractions.We concluded that subendometrial-myometrial contractions studied on the day of embryo transfer (luteal day 2) do not predict the outcome in in vitro fertilization cycles.     

不同细胞数的卵裂期胚胎囊胚培养及冻融后单囊胚移植结局

目的:探索卵裂期胚胎细胞数对囊胚发育的影响,以及对冻融后单囊胚移植结局的影响。方法:回顾性选择D3胚胎评分A和B级5754枚行囊胚培养的胚胎,分为三组A组7~9细胞;B组≥10细胞;C组4~6细胞。比较三组的囊胚培养情况。选择177个单囊胚解冻移植周期,按照囊胚来源的D3胚胎评分A和B级分为两组A组7~9细胞和B组≥10细胞,比较冻融后单囊胚移植的结局。结果:三组胚胎囊胚培养结局比较,囊胚形成率、优质囊胚率、D5囊胚形成率和D5优质囊胚率差异极显著(P<0.01),但B组与A组比较,囊胚形成率、优质囊胚率差异不显著(P>0.05),D5囊胚形成率差异极显著(P<0.01),D5优质囊胚率差异显著(P<0.05)。冻融后单囊胚移植,两组D5囊胚比率和临床妊娠率差异不显著(P>0.05),但两组女方年龄差异极显著(P<0.01)。结论:在排除碎片的影响后,囊胚发育与D3胚胎细胞数有关,4~6细胞的囊胚形成率最低,而≥10细胞与7~9细胞相比则无差异;冻融后单囊胚移植虽然≥10细胞与7~9细胞比较临床妊娠率无显著差别,但未排除女方年龄的差异。     

Reproducibility of three-dimensional ultrasound diagnosis of congenital uterine anomalies.

OBJECTIVE: To examine the reproducibility of the diagnosis of congenital uterine anomalies and the repeatability of measurements of uterine cavity dimensions using three-dimensional (3D) ultrasound. METHODS: The reproducibility of diagnosis of congenital uterine anomalies was examined by re-slicing stored 3D ultrasound volumes. Each data set was evaluated by two independent observers. Assessment of uterine morphology was performed in a standardized plane, with the interstitial portions of the Fallopian tubes used as reference points. Additionally, in 35 cases of congenital uterine anomalies the width of the uterine cavity (W), fundal distortion (F) and the length of unaffected uterine cavity (C) were measured. Intraobserver and interobserver variabilities were evaluated by each observer performing all three measurements twice. RESULTS: Eighty-three 3D ultrasound volumes were examined. Both operators classified 27 uteri as normal, 33 as arcuate, 19 as subseptate and three as unicornuate. A single case of uterine anomaly was described as arcuate uterus by one operator and subseptate by another (kappa 0.97). The intraobserver variability for each of the three measurements (W, F and C) was satisfactory with limits of agreement ranging from +/-1.43 to +/-2.51 mm. The examination of the interobserver variability showed no significant differences between the two observers (F = 0.484, P > 0.05). CONCLUSION: 3D ultrasound is a reproducible method for the diagnosis of congenital uterine anomalies and for the measurement of uterine cavity dimensions.     

体外受精-胚胎移植超排周期中子宫内膜超声监测对妊娠的预测价值

目的：探讨体外受精－胚胎移植（ＩＶＦ－ＥＴ）超排过程中子宫内膜监测对选择ＨＣＧ用药时机及预测妊娠结局的价值。方法：使用阴道超声监测体外受精－胚胎移植超排卵过程中３２例不孕患者子宫内膜厚度及特征变化。结果：妊娠组与未妊娠组子宫内膜厚度比较差异有显著性意义（Ｐ＜０００５）,妊娠组取卵日子宫内膜厚度均＞１１ｍｍ。两组子宫内膜特征分布无明显差异。结论：阴道超声监测子宫内膜厚度对预测胚胎种植内环境及妊娠预后具有一定的价值。     

Accurate guidance of a catheter by ultrasound imaging and identification of a catheter tip by pulsed-wave Doppler

Background: With the advent of numerous minimally invasive medical procedures, accurate catheter guidance has become imperative. We introduce and test an approach for catheter guidance by ultrasound imaging and pulsed‐wave (PW) Doppler. Methods: A steerable catheter is fitted with a small piezoelectric crystal at its tip that actively transmits signals driven by a function generator. We call this an active‐tip (AT) catheter. In a water tank, we immersed a “target” crystal and a rectangular matrix of four “reference” crystals. Two‐dimensional (2D) ultrasound imaging was used for initial guidance and visualization of the catheter shaft, and then PW Doppler mode was used to identify the AT catheter tip and guide it to the simulated target that was also visible in the 2D ultrasound image. Ten guiding trials were performed from random initial positions of the AT catheter, each starting at approximately 8 cm from the target. Results: After the ten navigational trials, the average final distance of the catheter tip from the target was 2.4 ± 1.2 mm, and the range of distances from the trials was from a minimum of 1.0 mm to a maximum of 4.5 mm. Conclusions: Although early in the development process, these quantitative in vitro results show promise for catheter guidance with ultrasound imaging and tip identification by PW Doppler. (PACE 2012; 35:44–50)